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Galic A, Tyranska-Fobke A, Kuich A, Zapasnik A, Robakowska M. Analysis of the Effectiveness of Coordinated Care in the Management of Pharmacotherapy of Patients with Hypertension and Comorbidities in Primary Care-Preliminary Reports. Healthcare (Basel) 2024; 12:1146. [PMID: 38891221 PMCID: PMC11172043 DOI: 10.3390/healthcare12111146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Hypertension (HTN) is the dominant cause of cardiovascular disease and premature death worldwide. Also in Poland, the number of people with HTN is steadily increasing. In order to improve care for patients with HTN and other chronic diseases, a pilot of the POZ PLUS coordinated-care model was introduced. The pilot ran from 1 July 2018 to 30 September 2021 at 47 facilities nationwide. The purpose of this study was to conduct a preliminary analysis of the effectiveness of this model of care. The study focused on the management of pharmacotherapy in patients with hypertension and other comorbidities. The study included a group of 90 patients with HTN. Fifty-nine people were in the coordinated-care study group and 31 in the control group. Data were collected from electronic medical records. The analysis showed a trend toward greater blood-pressure reduction in patients under coordinated care (-4 mmHg difference in systolic blood pressure between the second and first visits and -2 mmHg difference in diastolic pressure between the second and first visits, p = 0.180 and p = 0.156). This suggests the preliminary conclusion that coordinated care in the PCP plus model might have positively affected the outcomes of patients with HTN. Further studies on the subject are planned.
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Affiliation(s)
- Aleksandra Galic
- Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Anna Tyranska-Fobke
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | | | | | - Marlena Robakowska
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Xu L, Xu N, Jiang X, Peng H, Wu Y, Lang Z, Zhou L, Ma D, Chen Z, Yin C, Yu Q. Study on the evaluation and influencing factors of contracted residents on the coordination of primary medical institutions. Front Public Health 2024; 12:1307765. [PMID: 38894990 PMCID: PMC11183267 DOI: 10.3389/fpubh.2024.1307765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/09/2024] [Indexed: 06/21/2024] Open
Abstract
Background The implementation of family doctor contract service is a pivotal measure to enhance primary medical services and execute the hierarchical diagnosis and treatment system. Achieving service coordination among various institutions is both a fundamental objective and a central element of contract services. Objective The study aims to assess residents' evaluations and determining factors related to the coordination of health services within primary medical institutions across different regions of Shandong Province. The findings intend to serve as a reference for enhancing the coordination services offered by these institutions. Methods The study employed a multi-stage stratified random sampling method to select three prefecture-level cities in Shandong Province with different economic levels. Within each city, three counties (districts) were randomly sampled using the same method. Within each county (district), three community health service centers and township health centers implementing family doctor contract services were selected randomly. Face-to-face questionnaire surveys were conducted with contracted residents using the coordination dimension of the revised Primary Care Assessment Tools Scale (PCAT) developed by the research team. Data analysis was conducted using such methods as one-way analysis of variance and multiple linear regression. Results The sample included 3,859 contracted residents. The coordination dimension score of primary medical institutions averaged 3.41 ± 0.18, with the referral service sub-dimension scoring 3.60 ± 0.58 and the information system sub-dimension scoring 3.34 ± 0.65. The overall score of the referral service sub-dimension surpassed that of the information system sub-dimension. Regression results indicated that the city's economic status, the type of contracted institutions, gender, education, marital status, income, occupation, health status, and endowment insurance payment status significantly influenced the coordinated service score of primary medical institutions (p < 0.05). Conclusion The coordination of primary medical institutions in Shandong Province warrants further optimization. Continued efforts should focus on refining the referral system, expediting information infrastructure development, enhancing the service standards of primary medical institutions, and fostering resident trust. These measures aim to advance the implementation of the hierarchical diagnosis and treatment and two-way referral system.
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Affiliation(s)
- Lingfeng Xu
- School of Management, Shandong Second Medical University, Shandong, China
| | - Na Xu
- School of Management, Shandong Second Medical University, Shandong, China
| | - Xiaoli Jiang
- School of Management, Shandong Second Medical University, Shandong, China
| | - Haibo Peng
- School of Management, Shandong Second Medical University, Shandong, China
| | - Yixuan Wu
- School of Management, Shandong Second Medical University, Shandong, China
| | - Zihan Lang
- School of Management, Shandong Second Medical University, Shandong, China
| | - Lifang Zhou
- School of Public Health, Shandong Second Medical University, Shandong, China
| | - Dongping Ma
- School of Management, Shandong Second Medical University, Shandong, China
| | - Zhongming Chen
- School of Management, Shandong Second Medical University, Shandong, China
| | - Chengliang Yin
- School of Basic Medical Sciences, Shandong Second Medical University, Shandong, China
| | - Qianqian Yu
- School of Management, Shandong Second Medical University, Shandong, China
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Skjærpe JN, Iakovleva TA, Storm M. Responsible coordination of municipal health and care services for individuals with serious mental illness: a participatory qualitative study with service users and professionals. BMC Health Serv Res 2024; 24:633. [PMID: 38755572 PMCID: PMC11100197 DOI: 10.1186/s12913-024-10999-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Care coordination is crucial to ensure the health of individuals with serious mental illness. The aim of this study was to describe and analyze an inclusive innovation process for coordinating municipal health and care services for individuals with serious mental illness. METHODS We conducted café dialogues with professionals and service users with serious mental illness. The café dialogues engaged participants in conversation and knowledge exchange about care coordination, adressing topics of efficiency, challenges, and improvement. We used a responsible innovation framework to analyze the innovation process. RESULTS Responsible coordination requires promoting service users' health and ensuring communication and mutual awareness between professionals. Individual-level factors supporting responsible coordination included service users knowing their assigned professionals, personalized healthcare services, and access to meaningful activities. Provider-level factors included effective coordination routines, communication, information exchange, and professional familiarity. Results reflect professionals' and service users' perspectives on efficient care coordination, existing challenges, and measures to improve care coordination. CONCLUSION Café dialogues are an inclusive, participatory method that can produce insights into the responsible coordination of municipal health and care services for individuals with serious mental illness. The responsible innovation framework is helpful in identifying care coordination challenges and measures for responsible coordination.
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Affiliation(s)
- Jorunn Nærland Skjærpe
- Department of Public Health, University of Stavanger, Postbox 8600 FORUS, 4036, Stavanger, Norway.
| | | | - Marianne Storm
- Department of Public Health, University of Stavanger, Postbox 8600 FORUS, 4036, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Research Department, Research Group of Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
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Brooman-White R, Blakeman T, McNab D, Deaton C. Informing understanding of coordination of care for patients with heart failure with preserved ejection fraction: a secondary qualitative analysis. BMJ Qual Saf 2024; 33:232-245. [PMID: 37802647 DOI: 10.1136/bmjqs-2023-016583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) are a complex and underserved group. They are commonly older patients with multiple comorbidities, who rely on multiple healthcare services. Regional variation in services and resourcing has been highlighted as a problem in heart failure care, with few teams bridging the interface between the community and secondary care. These reports conflict with policy goals to improve coordination of care and dissolve boundaries between specialist services and the community. AIM To explore how care is coordinated for patients with HFpEF, with a focus on the interface between primary care and specialist services in England. METHODS We applied systems thinking methodology to examine the relationship between work-as-imagined and work-as-done for coordination of care for patients with HFpEF. We analysed clinical guidelines in conjunction with a secondary applied thematic analysis of semistructured interviews with healthcare professionals caring for patients with HFpEF including general practitioners, specialist nurses and cardiologists and patients with HFpEF themselves (n=41). Systems Thinking for Everyday Work principles provided a sensitising theoretical framework to facilitate a deeper understanding of how these data illustrate a complex health system and where opportunities for improvement interventions may lie. RESULTS Three themes (working with complexity, information transfer and working relationships) were identified to explain variability between work-as-imagined and work-as-done. Participants raised educational needs, challenging work conditions, issues with information transfer systems and organisational structures poorly aligned with patient needs. CONCLUSIONS There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work.
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Affiliation(s)
- Rosalie Brooman-White
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Blakeman
- Centre for Primary Care, University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Duncan McNab
- Medical Directorate, NHS Education for Scotland, Glasgow, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Olive MV, Gastaldi L, Corso M. Digitally-mediated coordination in healthcare: the effects of teleconsultation on doctor-to-doctor relational coordination. BMC Health Serv Res 2024; 24:258. [PMID: 38419009 PMCID: PMC10900703 DOI: 10.1186/s12913-024-10726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Digitalization transforms the way in which interdependent work is coordinated, especially in healthcare settings. This work deepens the effect of teleconsultation use on health professionals' coordination. For this aim, we rely on Relational Coordination Theory (RCT), which explores coordination as an interactive process among group participants within the context of task interdependency. METHODS We collected data through an online survey administered to Italian specialist doctors between March and April 2023. 489 complete answers were gathered. Hypotheses have been tested through Structural Equation Modelling. RESULTS We found that teleconsultation frequency of use has a positive and significant effect on both components of relational coordination, confirming our hypotheses. CONCLUSIONS Theoretically, this research contributes to our understanding of the effect of digitally mediated coordination mechanisms on relational coordination. In practice, we shed light on the organizational implications of telemedicine under a novel perspective, focusing on the role of professional interactions in digitally mediated work and providing useful elements for the organizational design of telemedicine.
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Affiliation(s)
- Mattia Vincenzo Olive
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy.
| | - Luca Gastaldi
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Mariano Corso
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
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Ojo S, Okoye TO, Olaniyi SA, Ofochukwu VC, Obi MO, Nwokolo AS, Okeke-Moffatt C, Iyun OB, Idemudia EA, Obodo OR, Mokwenye VC, Okobi OE. Ensuring Continuity of Care: Effective Strategies for the Post-hospitalization Transition of Psychiatric Patients in a Family Medicine Outpatient Clinic. Cureus 2024; 16:e52263. [PMID: 38352099 PMCID: PMC10863747 DOI: 10.7759/cureus.52263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
In healthcare, continuity of care is a crucial element, especially for patients in the field of psychiatry who have recently been discharged from a hospital. The shift from inpatient to outpatient care poses challenges for patients and healthcare providers, including openness to treatment, competing priorities, financial insecurity, concerns and dilemmas faced by patients regarding their post-hospitalization life after improvements in symptoms, lack of social support, poor patient-doctor relationships, lack of insight, and stigma associated with mental illness. Therefore, it is vital to employ effective strategies to ensure patients receive the required care and support during this transition. This review delves into the significance of continuity of care for psychiatric patients post-hospitalization, effective strategies for the transition, and the challenges and barriers to implementation from the perspective of a family medicine practice. To analyze physicians' role in managing psychiatric patients post-hospitalization, we developed a comprehensive search strategy. This involved extracting relevant data, updates, guidelines, and recommendations. Our search spanned various online repositories, such as PubMed and Google Scholar, specifically focusing on US-based guidelines aligned with our objectives. The search was conducted using medical subject headings (MeSH) and combinations of "OR," "AND," and "WITH." We crafted keywords to optimize our search strategy, including psychiatric illness, post-hospitalization, follow-up, follow-up care, primary care follow-up, and guidelines. Exploring online repositories yielded 132 articles, and we identified some guidelines that addressed our objectives. We established inclusion and exclusion criteria for our review and reviewed 21 papers. Post-hospitalization follow-up is a critical facet of psychiatric care, aligning with guidelines from the American Psychiatric Association and other relevant sources. Emphasizing continuity of care ensures a smooth transition from inpatient to outpatient settings, sustaining therapeutic momentum and minimizing the risk of relapse. This comprehensive approach involves careful medication management, regular mental health assessments, education on condition-specific coping strategies, and coordinated care between healthcare providers. It includes conducting risk assessments, safety planning, building social support and community integration, prompt post-hospitalization follow-up, and tailored treatment plans. Together, these measures enhance overall wellness for recently discharged patients. This holistic strategy tackles pressing short-term needs while facilitating long-term stability, promoting resilience and successful community reintegration, reducing readmission likelihood, and ultimately supporting sustained recovery.
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Affiliation(s)
- Soji Ojo
- Psychiatry, University of Texas Health Science Center at Houston, Dallas, USA
| | | | - Seyi A Olaniyi
- Medicine and Surgery, Obafemi Awolowo University, Ile-Ife, NGA
| | - Victor C Ofochukwu
- Medicine, Ebonyi State University, Abakaliki, NGA
- Medicine and Surgery, Hospital Corporation of America (HCA) Houston Healthcare Pearland, Pearland, USA
| | - Maureen O Obi
- General Practice, Federal Teaching Hospital, Owerri, NGA
| | | | - Chinwe Okeke-Moffatt
- Psychiatry and Behavioral Sciences, Washington University School of Health Sciences, San Pedro, BLZ
| | - Oluwatosin B Iyun
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, ZAF
| | - Etinosa A Idemudia
- Psychiatry and Behavioral Sciences, North Vista Hospital, Las Vegas, USA
| | | | - Violet C Mokwenye
- General Practice, University of Uyo, Uyo, NGA
- General Practice, National Hospital Abuja, Abuja, NGA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical center, Belle Glade, USA
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Khatri RB, Assefa Y. Drivers of the Australian Health System towards Health Care for All: A Scoping Review and Qualitative Synthesis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:6648138. [PMID: 37901893 PMCID: PMC10611547 DOI: 10.1155/2023/6648138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/03/2023] [Accepted: 10/07/2023] [Indexed: 10/31/2023]
Abstract
Background Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia. Methods We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level). Results A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users' language, access to health facilities, providers' behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations). Conclusion Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.
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Affiliation(s)
- Resham B. Khatri
- Health Social Science and Development Research Institute, Kathmandu, Nepal
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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ABOUTORABI ALI, DARVISHI TELI BANAFSHE, REZAPOUR AZIZ, EHSANZADEH SEYEDJAFAR, MARTINI MARIANO, BEHZADIFAR MASOUD. History of primary health care in Iran. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E367-E374. [PMID: 38125986 PMCID: PMC10730055 DOI: 10.15167/2421-4248/jpmh2023.64.3.3081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 12/23/2023]
Abstract
Background The history of the primary healthcare system in Iran portrays a journey of strategic development and implementation that has resulted in significant advancements in healthcare access and overall population well-being. Starting in the early 1980s, Iran embarked on a comprehensive approach to health care delivery prioritizing universal access, equity, and community participation. Introduction The foundation of this system was established during the Alma-Ata Conference in 1978, which placed a strong emphasis on the role of primary health care in attaining health for all.Iran's unwavering commitment to this approach led to the creation of an extensive network of rural and urban health centers designed to offer essential health services and preventive care to all citizens. Discussion Over the years, the expansion of Iran's primary healthcare system has yielded noteworthy accomplishments. Maternal and child mortality rates have seen substantial declines, attributed to improved access to maternal care and immunization services. The effectiveness of the system in reaching diverse populations has been enhanced through community engagement and the integration of traditional medicine. Furthermore, Iran's focus on health education and disease prevention has resulted in heightened public awareness and the adoption of healthier lifestyles. Despite these achievements, challenges continue to persist. Disparities in the quality and accessibility of services between urban and rural areas remain a concern. Moreover, the ongoing necessity for infrastructure development, training of the health workforce, and efficient resource allocation underscore the continuous efforts required to strengthen the primary healthcare system. Conclusions The history of Iran's primary health care system is marked by progress and achievements, underscored by an unwavering commitment to providing comprehensive, community-based care. Iran's journey serves as an exemplary model, highlighting the positive impact of prioritizing primary health care in achieving better health outcomes for its population. As Iran continues to evolve its health system, addressing challenges and building upon successes, the history of its primary health care system serves as a valuable lesson in the pursuit of accessible and equitable health care for all.
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Affiliation(s)
- ALI ABOUTORABI
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences,Tehran, Iran
| | - BANAFSHE DARVISHI TELI
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - AZIZ REZAPOUR
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences,Tehran, Iran
| | - SEYED JAFAR EHSANZADEH
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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